Immune checkpoint inhibitors plus taxane-based chemotherapy for patients with advanced/metastatic NSCLC: a systematic review and meta-analysis across different PD-L1 expression levels

Immune checkpoint inhibitors (ICIs) are currently the primary approach for managing NSCLC. However, numerous combination therapies are currently under investigation. Our goal is to investigate the overall efficacy and safety of ICIs and taxane-based chemotherapy. We conducted a systematic review and meta-analysis, searching web databases for relevant literature. We limited our eligibility to phase II/III randomized clinical trials involving advanced/metastatic NSCLC patients. We performed a meta-analysis encompassing nineteen studies derived from sixteen RCTs. For patients with sq-NSCLC PD-L1 ≥ 50%, using ICIs plus taxane significantly improve PFS and OS with HR of 0.58 (95% CI, 0.45–0.74, <i>p</i> &lt; 0.0001) and 0.41 (95% CI, 0.33–0.50, <i>p</i> &lt; 0.00001), respectively. For patients with non-sq NSCLC PD-L1 1–49%, the analysis revealed significant improvement of OS and PFS with HR of 0.64 (95% CI, 0.47–0.88, <i>p</i> = 0.005) and 0.62 (95% CI, 0.47–0.81, <i>p</i> = 0.0004), respectively. For TRAEs of all grades, ICIs plus taxane resulted with no significant difference compared to control group with risk ratio (RR) 1.00 (95% CI 0.99–1.02). The analysis revealed significant improvement in efficacy of ICIs with taxane in advanced/metastatic NSCLC patients compared with ICI/taxane monotherapy. <b>Registration:</b> PROSPERO (CRD42023447532).